Tomographic assessment of bone changes in atrophic maxilla treated by split-crest technique and dental implants with platelet-rich fibrin and NanoBone® versus platelet-rich fibrin alone: Randomized controlled trial.

BACKGROUND: This study evaluated the clinical benefits of adding NanoBone® with split-crest technique and simultaneous implant placement covered with platelet-rich fibrin membrane in horizontally deficient maxillary ridges in terms of crestal and horizontal bone changes and patient morbidity. METHODS: Forty patients indicated for maxillary ridge splitting and simultaneous implant placement were assigned randomly to the study groups: control group (Platelet Rich Fibrin membrane) and test group (Platelet Rich Fibrin membrane + Nanobone®). The Cone Beam Computed Tomography Fusion technique was utilized to assess crestal and horizontal bone changes after five months of the surgical procedure. Patient morbidity was recorded for one week post-surgical. RESULTS: Five months post-surgical, buccal crestal bone resorption was 1.26 ± 0.58 mm for the control group and 1.14 ± 0.63 mm for the test group. Lingual crestal bone resorption was 1.40 ± 0.66 mm for the control group and 1.47 ± 0.68 mm for the test group. Horizontal bone width gain was 1.46 ± 0.44 mm for the control group and 1.29 ± 0.73 mm for the test group. There was no significant statistical difference between study groups regarding crestal and horizontal bone changes and patient morbidity. CONCLUSIONS: The tomographic assessment of NanoBone® addition in this study resulted in no statistically significant difference between study groups regarding crestal and horizontal bone changes and patient morbidity. More randomized controlled clinical trials on gap fill comparing different bone grafting materials versus no grafting should be conducted. GOV REGISTRATION NUMBER: NCT02836678, 13th January 2017.

Assessment of bone gain and neurosensory affection with the sandwich osteotomy technique for vertically deficient posterior mandible using a full digital workflow versus conventional protocol: A randomized split mouth study.

BACKGROUND: Using the sandwich osteotomy technique in the posterior mandible is delicate. This study aimed to assess the safety and the amount of bone gain using a full digital workflow versus the conventional procedure. PATIENTS AND METHODS: This split mouth study included 10 patients with bilateral vertically deficient posterior mandible. One side received conventional sandwich interpositional bone grafting (control group), while the other side received the same protocol using two patient-specific guides. The first guide (cutting guide) was used to place the osteotomies safely and accurately according to the predetermined dimensions and locations, and the second guide was used to fix the mobilized bony segment, leaving the desired gap to be filled with a particulate xenogenic bone graft. RESULTS: Full neurosensory recovery was documented at 2 months postoperative for all patients and bilaterally. After 4 months, there was a statistically significant difference in vertical bone gain between both groups (p = 0.001), measuring an average of 3.76 ± 0.72 mm in the study group and 2.69 ± 0.37 mm in the control group. No statistically significant difference was found between the planned vertical augmentation (3.85 ± 0.58 mm) and the obtained vertical bone gain (3.76 ± 0.72 mm) in the study group (p = 0.765) proving the accuracy of the guided procedure. CONCLUSION: Computer-guided sandwich interpositional grafting is predictable regarding the execution of the osteotomies and the accuracy of fixation of the transport segment.

Ridge augmentation planning, wound healing evaluation, and peri-implant tissue phenotype assessment with ultrasonography: A case report.

BACKGROUND: Ridge regeneration for implant therapy requires comprehensive site evaluation and wound healing monitoring. This case report aimed to demonstrate ultrasound (US) can image soft and hard tissues for surgical planning and assess longitudinal outcomes. METHODS AND RESULTS: US was used in a patient planned for ridge augmentation to evaluate soft tissue thickness, location of muscle attachment, and hard tissue defect features presurgically. US were obtained at 1, 2.5, and 5 months afterward to assess tissue healing. Preoperatively, US showed ∼2.5 mm and ∼0.8 mm soft tissue thickness on the facial and lingual sides, respectively. The crestal bone width was ∼2 mm, with severe facial bone deficiency and high muscle attachment. US showed wound approximation and ridge width gain to 4.5 and 4.0 mm at 1 and 5 months, respectively. US tissue perfusion increased to ∼two-fold and ∼4-fold at 1 and 2.5 months and reduced below the baseline at 5 months. An implant with simultaneous bone augmentation was performed accordingly. Tissue phenotype around the implant was measured on US images at 1-year visit. CONCLUSIONS: This case report demonstrated that US parameters could be valuable for planning and wound healing outcome assessment of ridge augmentation in clinical as well as research settings. KEY POINTS: Why is this case new information? Novel high-resolution, chairside ultrasound was proposed to facilitate treatment planning and wound healing outcome assessment of ridge augmentation in clinical as well as research settings. What are the keys to successful use of this technology? Proper training in imaging acquisition and interpretation Adhere to high-level disinfection protocol Patient education and explanation What are the primary limitations to success in using this technology? Investment in this technology Learning curve in imaging acquisition and reading Insurance reimbursement strategy.

Clinical and histomorphometric soft tissue assessment comparing free gingival graft and a collagen matrix as alveolar-sealer materials: a randomized controlled pilot clinical trial.

OBJECTIVE: This study aimed to compare the alveolar sealing performance between free gingival graft (FGG) and porcine collagen membrane (MS) and qualitatively assess patient-centered outcomes via a visual analog scale. METHOD AND MATERIALS: Eighteen patients were randomly divided into control (FGG) and test (MS) groups. After extraction, all the alveoli were filled with bovine bone grafts (small granules) and sealed. Follow-up was during the immediate postoperative period and after 3, 7, 15, 30, 60, 90, and 120 days. After 180 days, before implant placement, tissue samples were obtained for histologic analysis. The epithelial tissues were morphometrically measured for each sample. Qualitative information on the patient's perception of the treatment was collected after 7 days. RESULTS: A faster healing was observed for the MS group. After 60 days, all the sites from the MS were partially healed, in contrast with only five from the FGG. The histologic results after 120 days showed for the FGG group a predominant acute inflammatory process, whereas chronic processes were observed for the MS group. The mean epithelial heights found for the FGG and MS were 535.69 µm and 495.33 µm, respectively (P = .54). The intragroup analysis showed significant variance among the data (P < .001) for both groups. The qualitative result showed statistically more significative comfort for the MS group (P < .05). CONCLUSION: Within the limitations of the study, both techniques effectively promote alveolar sealing. However, the visual analog scale result was superior and more significant for the MS group, with faster wound healing and lower discomfort.

Alveolar Ridge Augmentation Assessment Using a Minimalistic Approach, with and without Low-Level Laser Therapy (LLLT)-A Comparative Clinical Trial.

Background and Objective: A narrow alveolar ridge is an obstacle to optimal rehabilitation of the dentition. There are several complex and invasive techniques to counter the ridge augmentation dilemma, with most of them exhibiting low feasibility. Hence, this randomized clinical trial aims to evaluate the effectiveness of a Minimalistic Ridge Augmentation (MRA) technique, in conjunction with low-level laser therapy (LLLT). Materials and Methods: A total of 20 patients (n = 20) were selected, with 10 assigned to the test group (MRA+LLLT) and the other 10 to the control group (MRA). A vertical incision of approximately 10 mm was placed mesial to the defect and tunneled to create a subperiosteal pouch across the entire width of the defect. At the test sites, a diode laser (AnARC FoxTM Surgical Laser 810 nm) was used to deliver LLLT (parameters: 100 mW, with a maximum energy distribution of 6 J/cm2 in the continuous wave mode for 60 s per point) to the exposed bone surface inside the pouch, followed by graft (G-Graft, SurgiwearTM, Shahjahanpur, India) deposition with a bone graft carrier. The control sites were not irradiated with a laser. Results: A horizontal ridge width gain of >2 mm was observed in both groups. The changes in bone density for the test and control groups were -136 ± 236.08 HU and -44.30 ± 180.89 HU, respectively. Furthermore, there was no statistically significant difference between the test and control groups in these parameters. Conclusion: The study findings reveal that the MRA technique is relatively simple and feasible for alveolar ridge augmentation. The role of LLLT in the process requires further elucidation.

Clinical and radiographic assessment of cross-linked hyaluronic acid addition in demineralized bovine bone based alveolar ridge preservation: A human randomized split-mouth pilot study.

PURPOSE: To investigate clinically and radiographically at 4 months post-operatively the outcomes of mixing demineralized bovine bone material (DBBM) with cross-linked hyaluronic acid in alveolar ridge preservation. MATERIAL AND METHODS: Seven patients presenting bilateral hopeless teeth (14 teeth) were enrolled in the study, the test site contained demineralized bovine bone material (DBBM) mixed with cross-linked hyaluronic acid (xHyA) while the control site contained only DBBM. 4 months post-operatively prior to implant placement a Cone beam computed tomography (CBCT) scan was recorded and compared to the initial scan to assess the volumetric and linear bone resorption that occurred in both sites. Clinically, sites that needed further bone grafting at the implant placement stage were recorded. Differences in volumetric and linear bone resorption between both groups were assessed using Wilcoxon signed rank test. McNemar test was also used to evaluate difference in bone grafting need between both groups. RESULTS: All sites healed uneventfully, volumetric and linear resorption differences between the baseline and 4 months post-operatively were obtained for each site. The mean volumetric and linear bone resorption were respectively 36.56 ± 1.69%, 1.42 ± 0.16 mm in the controls sites and 26.96 ± 1.83%; 0.73 ± 0.052 mm in the tests sites. The values were significantly higher among controls sites (P=0.018). No significant differences were observed in the need for bone grafting between both groups. CONCLUSION: Cross-linked hyaluronic acid (xHyA) appears to limit the post-extractional alveolar bone resorption when mixed with DBBM.

Three-dimensional volumetric assessment of hard tissue alterations following horizontal guided bone regeneration using a split-thickness flap design: A case series.

OBJECTIVES: To analyze morphological, volumetric, and linear hard tissue changes following horizontal ridge augmentation using a three-dimensional radiographic method. METHODS: As part of a larger ongoing prospective study, 10 lower lateral surgical sites were selected for evaluation. Horizontal ridge deficiencies were treated with guided bone regeneration (GBR) using a split-thickness flap design and a resorbable collagen barrier membrane. Following the segmentation of baseline and 6-month follow-up cone-beam computed tomography scans, volumetric, linear, and morphological hard tissue changes and the efficacy of the augmentation were assessed (expressed by the volume-to-surface ratio). RESULTS: Volumetric hard tissue gain averaged 605.32 ± 380.68 mm3. An average of 238.48 ± 127.82 mm3 hard tissue loss was also detected at the lingual aspect of the surgical area. Horizontal hard tissue gain averaged 3.00 ± 1.45 mm. Midcrestal vertical hard tissue loss averaged 1.18 ± 0.81 mm. The volume-to-surface ratio averaged 1.19 ± 0.52 mm3/mm2. The three-dimensional analysis showed slight lingual or crestal hard tissue resorption in all cases. In certain instances, the greatest extent of hard tissue gain was observed 2-3 mm apical to the initial level of the marginal crest. CONCLUSIONS: With the applied method, previously unreported aspects of hard tissue changes following horizontal GBR could be examined. Midcrestal bone resorption was demonstrated, most likely caused by increased osteoclast activity following the elevation of the periosteum. The volume-to-surface ratio expressed the efficacy of the procedure independent of the size of the surgical area.

Alveolar ridge preservation: Complications and cost-effectiveness.

Alveolar ridge preservation is routinely indicated in clinical practice with the purpose of attenuating postextraction ridge atrophy. Over the past two decades numerous clinical studies and reviews on this topic have populated the literature. In recent years the focus has primarily been on analyzing efficacy outcomes pertaining to postextraction dimensional changes, whereas other relevant facets of alveolar ridge preservation therapy have remained unexplored. With this premise, we carried out a comprehensive evidence-based assessment of the complications associated with different modalities of alveolar ridge preservation and modeled the cost-effectiveness of different therapeutic modalities as a function of changes in ridge width and height. We conclude that, among allogeneic and xenogeneic bone graft materials, increased expenditure does not translate into increased effectiveness of alveolar ridge preservation therapy. On the other hand, a significant association between expenditure on a barrier membrane and reduced horizontal and vertical ridge resorption was observed, though only to a certain degree, beyond which the return on investment was significantly diminished.

Assessment of soft and hard tissue characteristics of ridge preservation at molar extraction sites with severe periodontitis: a randomized controlled trial.

BACKGROUND: Changes in alveolar bone dimension after tooth extraction may affect placement of the subsequent implant, resulting in ridge deficiency that can adversely impact long-term implant stability or aesthetics. Alveolar ridge preservation (ARP) was effective in reducing the amount of ridge resorption following tooth extraction. There is sparse evidence regarding the benefit of ARP at periodontally compromised molar extraction sockets. This study will be a randomized trial to assess the soft tissue contour, radiographical, and histological changes of ARP at molar extraction sites in order to compare severe periodontitis cases with natural healing results and determine the most beneficial and least traumatic clinical treatment for such patients. METHODS: This research is designed as a two-group parallel randomized controlled trial. The total number of tooth extraction sites will be 70 after calculation with power analysis. Teeth will be randomly assigned to two groups with the test group conducting ridge preservation and the control group healing naturally. Periodontal examination, cone beam-computed tomography (CBCT) data, and stereolithographic (STL) files obtained by intraoral scanning will be collected through the follow-up period, and bone biopsy samples would be obtained during implant surgery. The primary outcomes are the vertical and horizontal change of alveolar ridge measured on CBCT images, soft tissue contour changes evaluated by superimposing the digital impressions, alterations of mucosa thickness (as measured by superimposing the CBCT data and STL files), histological features of implant sites and periodontal parameter changes. The secondary outcomes are patient-reported post-operative reaction and conditions of simultaneous bone graft or sinus lifting procedures during implantation. DISCUSSION: This study will provide information about hard and soft tissue dimension changes and histomorphology evaluation following ARP and natural healing in periodontally compromised molar sites, which may contribute to complement the missing information of ARP at periodontally compromised molar extraction sockets. TRIAL REGISTRATION: Chinese Clinical Trial Register (ChiCTR) ChiCTR2200056335. Registered on February 4, 2022, Version 1.0.

Comparative Assessment of Bovine Versus Porcine Xenograft for Augmentation: A Randomized Prospective Cohort Study.

This study compared the bone turnover and volume stability of bovine-derived xenografts (Cerabone) vs porcine-derived xenografts (MinerOss XP) in horizontal ridge augmentation (HRA) for veneer contour and extraction socket preservation (ESP), with a 6-month follow-up. Participants were divided into Group 1 (HRA + bovine), Group 2 (HRA + porcine), Group 3 (ESP + bovine), and Group 4 (ESP + porcine). Buccolingual ridge width was measured on CBCT scans at baseline and 6 months. Representative histologic core samples were taken from the ESP groups at 6 months. Each group comprised 10 subjects (40 subjects total). The buccolingual width for Groups 1 and 2 increased from 5.43 ± 1.82 mm and 5.75 ± 1.64 mm (P = .36) to 7.75 ± 1.91 mm and 8.75 ± 1.38 mm (P = .03), respectively. However, the buccolingual widths for Groups 3 and 4 decreased from 6.3 ± 1.26 mm and 6.74 ± 1.29 mm (P = .16) to 5.8 ± 1.21 mm and 6.61 ± 1.56 mm (P = .01), respectively. Significantly lower dimensional changes were noted in Group 4 at 6 months. Porcine xenografts serve as a stable biocompatible osteoconductive bone substitute and expand a clinician's choice of bone grafts in dental applications.

Comparing the histological assessment following ridge preservation using a composite bovine-derived xenograft versus an alloplast hydroxyapatite-sugar cross-linked collagen matrix.

BACKGROUND: This randomized controlled trial was designed to evaluate the histological wound healing and alveolar ridge dimensional changes following ridge preservation using two different xenograft/collagen matrices. METHODS: Fifty-four patients each with non-molar teeth that required extraction and replacement with dental implants were enrolled. Teeth extractions were completed with minimal flap reflection and were randomized to receive ridge preservation with either 90% bovine-derived xenograft granules in a 10% porcine collagen matrix (Group A) or a sponge-like matrix of 80% microparticulate hydroxyapatite alloplast graft with 20% sugar cross-linked porcine type 1 collagen (Group B). After 16 weeks of healing and at the time of implant placement, a bone core biopsy was harvested followed by dental implant placement. The primary histological outcome evaluated were percentage of vital bone formation and connective tissue/other (fibrous tissue and marrow space). Secondary outcomes included the change in alveolar ridge width and the buccal and lingual ridge height. Statistical analysis was completed with two-sample t-test and Fisher exact test. RESULTS: Forty-four patients completed the study, 23 in group A and 21 in group B. Group B presented with statistically significantly (p = 0.02) more percentage of vital bone (39.3 ± 17.8) than group A (26.8 ± 15.8). No statistically significant difference was observed for changes in alveolar ridge dimensions. CONCLUSIONS: Group B, when used for ridge preservation, yields statistically significantly more vital bone over a 4-month healing period. Ridge dimension changes were similar between the two groups and were adequate for implant placement.

Autogenous dentin block versus bone block for horizontal alveolar ridge augmentation and staged implant placement: A randomized controlled clinical trial including histologic assessment.

OBJECTIVES: This study aimed to compare the dentin block (D-group) harvested from impacted wisdom teeth with autogenous ramus bone block (A-group) for horizontal alveolar ridge augmentation. MATERIALS AND METHODS: Forty-two patients with anterior missing teeth and horizontal ridge defect were randomly assigned to two groups (n = 21 per group) to receive either dentin block group or autogenous bone block. Six months after the augmentation, dental implants were placed in all patients, and a core biopsy was performed for histological evaluation in addition to clinical and radiographic evaluation using cone beam computed tomography. The primary outcome was the mean overall clinical ridge width gain (CRWG) after 6 months of augmentation. Secondary outcomes were the overall radiographic ridge width gain (RRWG) after 6 months of augmentation and descriptive histological analysis with histomorphometric assessment of bone fraction %. RESULTS: All sites healed uneventfully, and the mean overall CRWG 6 months after augmentation was 3.52 ± 0.56 mm and 2.24 ± 0.86 mm in the D and A groups, respectively, with statistically significant difference between them (P ≤ .001). The overall mean RRWG was 3.61 ± 0.61 mm and 3.41 ± 1.15 mm in D and A groups, respectively, without any statistically significant difference between them (p = .062). The histomorphometric analysis of the bone area fraction was 42.6% and 41.3% in D and A groups, respectively, without any statistically significant difference between the two values (p = .89, Student's t-test). Histological evaluation in the D-group revealed new bone formation, viable cells, and matrix formation on the dentin block periphery, in addition to well-organized woven bone that suggests dentin block remodeling and supports new bone deposition. CONCLUSION: The present clinical study revealed that dentin block may serve as an alternative graft to support horizontal alveolar ridge augmentation. Dentin blocks showed less resorption than autogenous bone blocks.

An Updated Decision Tree for Horizontal Ridge Augmentation: A Narrative Review.

Horizontal ridge augmentation is a common surgical procedure performed prior to or simultaneously with implant placement, depending on the extent of the ridge deficiency. Many horizontal augmentation surgical options have been developed, spanning a wide range of materials and techniques. Given the numerous permutations available, the most suitable strategy to regenerate ridge width for an individual case often confounds clinicians. Based on an extensive review of the literature, this article provides up-to-date technique selection guidelines, in the form of a decision tree, for predictable horizontal bone augmentation dependent on the amount of bone gain needed.

Assessment of a Novel Alveolar Ridge Preservation Concept in Dehiscence Sockets: A Pilot Study.

In this prospective pilot study on ridge preservation (RP), a collagen sponge was placed to fill the bottom half of the socket, followed by a sequence of bone graft, collagen membrane, and a sponge placed on top. Twelve patients with 13 hopeless posterior teeth were included. Changes in bone dimension (including variations of horizontal ridge width [HRW] and bone height [BH]) between the time immediately postextraction (T0) and 6 months later (T6M) were evaluated through CBCT. The soft tissue was assessed using a wound healing index (WHI) at 2 weeks (T2W), 2 months (T2M), and 6 months (T6M) postsurgery. Measured at three parallel levels (1, 3, and 5 mm apical to the crest of the palatal plate), the mean HRW changes (T0 to T6M) ranged from 0.47 to 1.05 mm. Statistically significant negative correlations were observed between WHI (T6M) and midcrestal BH change. This proposed RP technique showed favorable outcomes regarding HRW and BH, even in periodontally compromised dehiscence sockets.

Quality assessment of systematic reviews on vertical bone regeneration.

The aim of this study was to evaluate and compare the quality of systematic reviews of vertical bone regeneration techniques, using two quality-assessment tools (AMSTAR and ROBIS). An electronic literature search was conducted to identify systematic reviews or meta-analyses that would evaluate at least one of the following outcomes: implant survival, success rates, complications or bone gain after vertical ridge augmentation. Methodological quality assessment was performed by two independent evaluators. Results were compared between reviewers, and reliability measures were calculated using the Holsti's method® and Cohen's kappa. Seventeen systematic reviews were included, of which seven presented meta-analysis. Mean ±95% confidence interval AMSTAR score was 6.35 [4.74;7.97], with higher scores being correlated with a smaller risk of bias (Pearson's correlation coefficient=-0.84; P<0.01). Cohen's inter-examiner kappa showed substantial agreement for both checklists. From the available evidence, we ascertained that, regardless of the technique used, it is possible to obtain vertical bone gains. Implant success in regenerated areas was similar to implants placed in pristine bone with results equating between 61.5% and 100% with guided bone regeneration being considered the most predictable technique regarding bone stability, while distraction osteogenesis achieved the biggest bone gains with the highest risk of possible complications.

Assessment of vertical ridge augmentation and labial prominence using buccal versus palatal approaches for maxillary segmental sandwich osteotomy (inlay technique): A randomized clinical trial.

BACKGROUND: The aim of this study was to evaluate the final vertical gain at the deficient anterior maxillary alveolar ridges using buccal versus palatal approaches for maxillary segmental sandwich osteotomy (inlay technique). This is a single-institutional randomized comparative clinical trial. MATERIAL AND METHODS: The study population was 16 patients with edentulous anterior maxillary alveolar ridges (40 implant sites). Patients were randomly divided into two equal groups. Both groups received sandwich osteotomy with down fracture of the deficient anterior maxillary alveolar ridge, using buccal approach (control group) and palatal approach (study group) with interpositional alloplastic bone blocks fixed with miniplates. Assessment included the mean percentage of vertical gain at the proposed implant sites after 4 months, taken from cross-sectional cuts of a cone beam computed tomography. RESULTS: All cases showed uneventful wound healing and a total of 40 delayed implant placement were done. Results showed that there was no statistical significance between the 2 groups in terms of bone height (P = .43) and labial prominence (P = .5) CONCLUSION: Both techniques were successful where the mean percentage of 4 months postoperative vertical bone gain of the control group was 79.9% and that of the study group was 76.5%.

Decision Tree for Vertical Ridge Augmentation.

Vertical ridge augmentation (VRA) procedures before or during dental implant placement are technically challenging and often encounter procedure-related complications. To minimize complications and promote success, a literature search was conducted to validate procedures used for VRA. A decision tree based on the amount of additional ridge height needed (< 4, 4 to 6, or > 6 mm) was then developed to improve the procedure-selection process. At each junction, the clinician is urged to consider anatomical, clinical, and patient-related factors influencing treatment outcomes. This decision tree guides selection of the most appropriate treatment modality and sequence for safe, predictable management of the vertically deficient ridge in implant therapy.

Three-Dimensional Radiological Assessment of Alveolar Bone Volume Preservation Using Bovine Bone Xenograft.

INTRODUCTION: Alveolar bone is critical in supporting natural teeth, dental implants as well as a removable and fixed prosthesis. Alveolar bone volume diminishes when its associated natural tooth is lost. OBJECTIVE: The aim of this study is to evaluate the effectiveness of bovine bone granules on alveolar bone socket augmentation for ridge preservation following atraumatic tooth extraction. MATERIALS AND METHODS: Twenty medically fit patients (12 males and 8 females aged between 18 and 40 years) who needed noncomplicated tooth extraction of 1 mandibular premolar tooth were divided randomly and equally into 2 groups. In control group I, the empty extraction socket was left untreated and allowed to heal in a conventional way. In group II, the empty extraction socket wound was filled with lyophilized bovine bone xenograft granules 0.25 to 1 mm of size, 1 mL/vial. A resorbable pericardium membrane was placed to cover the defect. Clinical and 3-dimensional radiological assessments were performed at day 0, 3 months, and 9 months postoperative. RESULTS: There were no clinical differences in general wound healing between the groups. Comparisons within the groups showed a significant difference of bone resorption of 1.49 mm (95% confidence interval, 0.63-2.35) at 3 months, and further resorption of 1.84 mm (P ≤ 0.05) at 9 months in the control group. No significant changes of bone resorption were observed in group II during the same time interval. Comparison between groups showed a significant difference of bone resorption at 3 and 9 months (2.40 and 2.88 mm, respectively). CONCLUSION: The use of lyophilized demineralized bovine bone granules in socket preservation to fill in the extraction socket seems essential in preserving the alveolar bone dimension as it showed excellent soft and hard tissue healing. This study concludes that the alveolar bone socket exhibited a dynamic process of resorption from the first day of tooth extraction. Evidence shows the possibility of using bovine bone granules routinely in socket volume preservation techniques following tooth extraction.

Clinical applications and effectiveness of guided implant surgery: a critical review based on randomized controlled trials.

BACKGROUND: Nowadays implant placement protocols are widespread among clinicians all over the world. However, available literature, only partially analyses what can be potential benefits for the clinicians and patients, often focusing just on specific aspects, such as accuracy. The purpose of this review is to compare computer guided implant placement with conventional treatment protocols. METHODS: A search strategy according to the P-I-C-O format was developed and executed using an electronic MEDLINE plus manual search from 2000 up to December 2016. This review included only randomized controlled trials (RCTs) focusing on subjects treated with digital workflow for oral implant placement compared to conventional procedures. Data were extracted from eligible papers and analysed. All kinds of outcomes were considered, even patient-related and economical outcomes. RESULTS: The search strategy revealed 16 articles; additional manual searches selected further 21 publications. Afterwards the evaluation of articles, only two studies could be selected for subsequent data extraction. The two identified RCTs analysed primary outcomes as prosthesis failure, implant failure, biological or prosthetic complications, and secondary outcomes as periimplant marginal bone loss. One RCT evaluated also the duration of treatment, post-surgical progress, additional treatment costs and patient satisfaction. The other RCT focused instead on evaluating eventual improvement of patient's quality of life. In both selected studies, were not observed by the authors statistically significant differences between clinical cases treated with digital protocols and those treated with conventional ones. In one RCT, however post-surgical progress evaluation showed more patients' self-reported pain and swelling in conventional group. CONCLUSIONS: Within the limitation of this review, based on only two RCTs, the only evidence was that implant survival rate and effectiveness are similar for conventional and digital implant placement procedures. This is also confirmed by many other studies with however minor scientific evidence levels. Reduction of post-operative pain, surgical time and overall costs are discussed. Authors believe that scientific research should focus more in identifying which clinical situations can get greatest benefits from implant guided surgery. This should be done with research protocols such as RCT that assess comprehensively the advantages and disadvantages of fully digital surgical protocols.

Assessment of vertical ridge augmentation in anterior aesthetic zone using onlay xenografts with titanium mesh versus the inlay bone grafting technique: A randomized clinical trial.

The aim of this study was to evaluate the final vertical gain at the deficient anterior maxillary alveolar ridges using onlay bone grafts with titanium mesh versus inlay bone grafting. This was a single institutional randomized comparative clinical trial. The study population included 16 patients, with edentulous anterior maxillary alveolar ridges (40 implant sites) who were presented and treated at the Faculty of Oral and Dental Medicine in Cairo University from September 2013 to August 2015. Selected patients were randomly divided into two equal groups. The control group received onlay particulate xenograft together with titanium mesh as a space-maintaining device while the study group received inlay block xenograft (sandwich osteotomy) fixed with mini-plates. Assessment using cone beam computed tomography (CBCT) included the mean percentage of vertical gain at the proposed implant sites after 6 months taken from cross-sectional cuts. A total of 40 delayed implant placements were done. Results showed that there was no statistical significance between the two groups (P=0.2); the mean percentage of 6 months postoperative vertical bone gain in the control group was 20.7% and that in the study group was 31.6%.